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'''A foaling mare is presented with dystocia. A manual examination finds a live foal in normal presentation; however, your findings indicate a caesarean section is likely to be the most successful means of delivery of a live foal.'''
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<FlashCard questions="4">
 
<FlashCard questions="4">
|q1=
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|q1= What conditions in the mare and foal would indicate the need for a caesarean section?
|a1=
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|a1= (1) A narrow pelvic canal; (2) an oversize foal; (3) a malpositioned live foal
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which cannot be manipulated to the normal position; (4) arthrogryposis; (5) dead
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foals where a fetotomy cannot be performed safely; (6) rupture of the abdominal
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musculature.
 
|l1=
 
|l1=
|q2=
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|q2= What surgical approaches can you use?
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|a2= (1) Low left flank approach is useful in large draught mares with large foals. An advantage is less myositis than when the mare is in dorsal recumbency; disadvantages are limited exposure; it is more difficult for deformed foals and for uterine torsion.
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(2) Caudal ventral midline approach. Advantages are it is a common familiar site for surgery, there is little haemorrhage from linea alba and exposure is better; disadvantages are the possibility of myositis from prolonged recumbency on the back muscles and it is more difficult to lift the foal out of the abdomen.
 
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|l2=
|q3=
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|q3= What complications can occur in mares during caesarean section and how would you manage them?
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|a3= (1) Contamination of abdominal cavity by uterine contents: expose the uterus and locate the feet, pull the uterus up and pack off with drapes; a heavy stay suture can also be placed each end of the intended incision to hold the uterine edges up after delivery of the foal.
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(2) Tearing of the uterine wall due to too small an incision: make sure the uterine incision is enlarged by surgical cut, not tearing.
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(3) Control of uterine haemorrhage (which can be profuse): if the placenta is easily detached, remove it; if not, free back the placenta for 3 cm around the rim of the incision and place a continuous suture along each edge of the incision to control haemorrhage. Be very careful not to include allantochorion in the sutures.
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(4) Leakage of uterine lochia: use an appropriate suture pattern to close the incision.
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(5) Peritonitis from uterine lochia: lavage the abdominal cavity with warm normal saline and aspirate; a final wash should contain penicillin and gentamycin.
 
|l3=
 
|l3=
|q4=  
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|q4= What post-operative complications can occur and how would you manage them?
|a4=
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|a4= A retained placenta: (1) IV drip oxytocin 50 IU in 1 litre of saline solution over 1 hour if the placenta is not passed during the anaesthetic recovery period or use 20–40 IU oxytocin IM every hour.
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(2) Contamination infection of the vagina, cervix and uterus: where trauma to the vagina, cervix, etc. has occurred prior to caesarean section, and with prolonged placental retention, use gentle uterine lavage with warm normal saline commencing 24 hours post-operatively; avoid over-distension.
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(3) Postsurgical dehydration and infection: use IV fluids, parenteral antibiotics and NSAIDs for 3–5 days. Reassess the need for further treatment each day.
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(4) Post-surgical ileus and/or constipation: use a laxative diet and make sure the mare drinks water or is given IV fluids.
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(5) Swelling of limbs: increase hand walking exercise or turn out in a small paddock 3–4 times daily.
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(6) Post-surgical complications related to any abdominal surgery: incisional infection, wound dehiscence, colic due to bowel injury during parturition or during surgery and laminitis.
 
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</FlashCard>
 
</FlashCard>
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